THE PROGNOSIS

Federal regulators are requiring Oregon to ensure its child welfare workers don’t discriminate against parents with disabilities, after the state lost its bid to take away the children of a low-IQ couple in a high-profile court battle.

This morning, the Office of Civil Rights at the Department of Health and Human Services will announce an agreement with Oregon for the state to develop a system for ensuring its employees comply with federal law banning discrimination based on someone’s disability, whether it's physical or intellectual. Over the next two years, the state must set up training programs, provide OCR with written reports and review 10 specific cases to determine whether it acted appropriately, among other steps.

“We do commend Oregon for doing the right thing of looking hard at their policies and doing what they can to put safeguards in place so nobody falls through the cracks and ends up losing custody of their children,” OCR Director Roger Severino told The Health 202 in an interview yesterday.

Severino said the investigation into Oregon was prompted by the case of Amy Fabbrini and Eric Ziegler — a couple with below-average scores on an IQ test who lost custody shortly after both their children were born. 

The couple’s IQ scores were low enough for them to have borderline mental disabilities — Fabbrini’s score was 72, while Ziegler’s was 66 — but both had graduated from high school and had taken parenting, nutrition and CPR classes to try to show their ability to care for their boys.

Yet the children were put in foster care over concerns the parents weren’t able to create a safe environment and were only returned after courts ordered it, when the boys were 4 years old and 10 months old. Deschutes County Judge Bethany Flint ruled in January 2018 that there wasn’t enough evidence to show Fabbrini and Ziegler couldn’t safely parent.

“The default presumption should be children stay with their parents and a person having an intellectual disability should not automatically change that presumption,” Severino told me.

Inside Edition did a story on the family:

Severino said his office reviewed Oregon’s compliance with federal nondiscrimination laws and found “systemic” issues with how the state follows federal law to prevent discrimination against parents with disabilities in Oregon’s child welfare system.

But OCR hasn’t reached an official conclusion on whether the state violated the laws. That’s because Oregon has agreed to undergo a self-examination process — a common way for entities to avoid being slapped with a finding of violation and potential loss of federal dollars.

"The Oregon Department of Human Services believes that all children and their families should be safe, healthy, and treated with equity and respect,” Fariborz Pakseresht, director of the state's Department of Human Services, said in a statement. “We appreciate...the assistance of the Office of Civil Rights in helping identify areas for practice improvements to ensure that all families receive the supports and services that meet their individual needs."

Oregon previously said its workers didn’t remove Fabbrini and Ziegler’s children from them solely based on their IQ scores — although the couple insisted that was the primary reason.

But requiring parents to take IQ tests as even a partial determination of whether they should be allowed to keep their kids is controversial among some advocates, who say it’s an unfair way of determining who is fit to parent. 

“IQs test for problem-solving and short-term memory, basically which all goes out the window when a parent is under stress,” said Sherrene Hagenbach, who advocated on behalf of Fabbrini and Ziegler amid their court battle.

Hagenbach, who said she is also working with a deaf couple and an autistic father whose children were taken from them in Oregon, is the person who first alerted OCR to Fabbrini and Ziegler’s story back in fall 2018 and asked the department to investigate.

She’s glad to see the state launching a review but questions how much it will fix what she views as a systemic problem that is nationwide.

“I’m super excited to know they are able to review that case because it’s horrific on all levels,” she said. “I’m not sure this is gonna fix anything, but at least it’s a step in the right direction.”

AHH, OOF and OUCH

AHH: The Senate Health, Education, Labor and Pensions Committee voted 18 to 5 to approve the nomination of Texas radiation oncologist Stephen Hahn to be the new Food and Drug Administration commissioner -- but the panel's leading Democrat voted against him, our Post colleague Laurie McGinley reports.

“Committee Chairman Lamar Alexander (R-Tenn.) said before the vote that Hahn is ‘exactly the type of nominee’ that should lead the FDA, citing his management and research experience,” she writes. “But Sen. Patty Murray (D-Wash.), the panel’s ranking Democrat, voted against Hahn, saying during his confirmation hearing last month he had ‘refused to commit to implementing a strong policy to clear nontobacco e-cigarettes’ from the market — a step President Trump promised in September but has not finalized. Other Democrats split, with some voting for Hahn’s confirmation and others voting against him.”

Dozens of medical, patient and research groups this week pushed to quickly confirm Hahn, even as other groups, including the Campaign for Tobacco-Free Kids, said he shouldn’t be confirmed to the post until the Trump moves forward on its vaping policy.

OOF: The Trump administration released details of a new program to provide free HIV prevention medication to uninsured individuals. The program — called “Ready, Set, PrEP” — will provide drugs from drugmaker Gilead Sciences to reduce the number of HIV infections a year in the country by 90 percent by 2030.

The government also reported yesterday that just 40 percent of adults in the United States have ever been tested for HIV, and fewer than a fifth of people at high risk of developing the infection get the preventive medication, our Post colleague Lenny Bernstein reports.

“Dramatic improvement of testing and prevention, as well as better treatment of people who already have HIV, are urgently needed if the government is to reach President Trump’s goal of virtually wiping out transmission of the infection by 2030, the Centers for Disease Control and Prevention said,” he writes. “The announcement by Health and Human Services Secretary Alex Azar expands government efforts to provide the highly effective medication to more people at risk of contracting HIV, including African American and Latino men who have sex with men, intravenous drug users, people with mental illness and the homeless.”

Azar said about 200,000 uninsured individuals could get the free drug once they’ve tested negative for HIV and get a prescription. Three major pharmacy chains — CVS Health, Walgreens Boots Alliance, and Rite Aid — will be part of the program and will distribute the medication starting in March.

OUCH: Pete Buttigieg responded to the remarks from Democratic rival Joe Biden that the South Bend, Ind., mayor “stole” the former vice president’s health-care plan.

“Well, first of all, I’ve been talking about ‘Medicare for all who want it’ since at least February, and also the plans are not exactly the same,” Buttigieg said in an interview with CNN. “… Of course, I believe that our approach on health care is the best one, and I’m willing to bring that plan out and compete with any of my competitors on having the best plan.”

Biden said on the campaign trail this week that Buttigieg “doesn’t have the enthusiasm and the moderate — moderate plan. It’s the Biden plan.” “The former vice president then accused the media of going too easy on Buttigieg, saying his opponent had once supported a more liberal health care plan but then pivoted,” Politico’s Natasha Korecki reported. “Biden contended that if he had supported a different plan ‘and then I came along with the exact same plan, what would you have done to me? You would have torn my ears off. Absolutely, I would be a plagiarizing, no good, old man who did bum bum bum.’ ”

HEALTH ON THE HILL

— The House Oversight subcommittee on economic and consumer policy will hold a hearing today to examine the federal response to the epidemic of youth e-cigarette use.

The hearing follows recent reports that the Trump administration appears to be reversing course on a pledged ban on most flavored e-cigarettes.

“In a recent meeting with health groups, vaping advocates and tobacco executives at the White House, Trump expressed concern that a flavor ban could result in an increase in counterfeit products,” Laurie reports. “In a letter Monday, 28 members of Congress asked Trump to remove flavored e-cigarettes from the market until they are cleared by the FDA. Vaping advocates have argued that a flavor ban would hurt adults using e-cigarettes to quit smoking and that youth use should be reduced in other ways, such as by restricting where the products are sold.”

— Sens. Ron Wyden (D-Ore.) and Cory Booker (D-N.J.) are calling on the Centers for Medicare and Medicaid Services, the Federal Trade Commission and five major health-care companies to provide information about how they are addressing bias in algorithms used in their systems.

A study published in the journal Science in October found a widely used algorithm meant to predict patient needs underestimated the health needs of the sickest black patients, as our Post colleague Carolyn Y. Johnson reported then.

“In using algorithms, organizations often attempt to remove human flaws and biases from the process,” the lawmakers wrote in the letter to CMS Administrator Seema Verma, FTC Chairman Joseph Simons and top executives of UnitedHealth Group, Blue Cross Blue Shield, Cigna, Humana and Aetna. “Unfortunately, both the people who design these complex systems, and the massive sets of data that are used, have many historical and human biases built in. Without very careful consideration, the algorithms they subsequently create can further perpetuate those very biases. Health care systems are not immune to the problem of bias.”

— A little-known group, the Pharmaceutical Industry-Labor Management Association, is working to oppose drug-pricing proposals across the country, including House Speaker Nancy Pelosi’s (D-Calif.) bill to address drug costs.

The coalition includes major pharmaceutical companies and construction industry unions whose members build pharmaceutical plants and research facilities, the New York Times’s Katie Thomas reports. The group has put its money in ads on Facebook, print ads in local publications and mailers out to voters in Democratic districts to defeat such proposals on the state and federal levels.

Their message “aligns closely with the talking points of drug companies, which claim that Ms. Pelosi’s bill would stifle innovation and damage a vital American industry,” Katie writes. “Even in the nation’s capital, where coalitions and dark-money groups are routinely used to repackage corporate interests in a more sympathetic light, the pairing of the drug industry and unions is an unusual one. Many unions, including some who are members of Pilma, help oversee their workers’ health plans and have an interest in lowering drug costs. And out-of-pocket costs for prescription drugs are a financial strain on many Americans, including union members.”

— And here are a few more good reads:

Joe Biden is taking aim at Pete Buttigieg and Elizabeth Warren during an eight-day tour of Iowa that the former vice president hopes will help him gain ground in the state that holds the first presidential caucus.
Associated Press

OPIOID OPTICS

More than 1,000 pages of court records, unsealed after STAT's legal fight, offer the most complete picture of Sackler’s commanding presence inside Purdue.
Stat
STAT’s multiyear legal battle to unseal Purdue files has produced dozens of documents that lay bare new details about its OxyContin marketing campaign.
Stat
Local governments in regions hard hit by the U.S. opioid epidemic have opted out...
Reuters

MEDICAL MISSIVES

Thirty-seven percent of American adults don't plan to get flu shots this season, according to a poll released Tuesday.
The Hill

INDUSTRY RX

Media has a responsibility to share national crisis hotlines with their audience, researchers say.
Axios

DAYBOOK

Today

  • The House Energy and Commerce subcommittee on oversight and investigations holds a hearing on flu season preparedness and response.
  • The Senate Armed Services subcommittee on personnel holds a hearing on “servicemember, family, and veteran suicides and prevention strategies."
  • The House Energy and Commerce Subcommittee on Health holds a hearing on ""Building Consumer Confidence by Empowering FDA to Improve Cosmetic Safety." 
  • The House Education and Labor Committee holds a hearing on the impact of the Trump administration's immigration policies on children. 

SUGAR RUSH